Personally Speaking: GP and registered nurse defend the closure of community beds

GP Dr Steve Fawcett and registered nurse Tracey Shewan – the medical director and director of nursing and quality for both Stoke-on-Trent and Staffordshire CCGs respectively – defend the closure of community beds

Next year marks the 70th anniversary of the NHS, and few would argue it has been a staggering success.

Life expectancy has increased enormously since 1948. And more people now live well with complex conditions that once would have been extremely life-limiting.

This means the NHS has to adapt to challenging circumstances with constantly increasing demand. But adaptation is something the NHS has always had to do.

Locally we are meeting this need to adapt, and this includes looking at the way we use our local community hospitals – Leek, Bradwell, Longton, the Haywood and Cheadle. They are well-loved and provide services people value.

But we are now exploring whether we can do things differently and provide enhanced services with the resources we have. By resources we don’t just mean money, but also staff, equipment and buildings.

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This will be the subject of consultation next year, and to help prepare for this we have been holding events where we’ve been asking people about what they believe the priorities are for local health services.

One thing that has been a cause of particular concern has been the issue of community beds in these hospitals. I need to briefly explain the difference between a community hospital bed and what the NHS calls an ‘acute’ hospital bed.

Acute beds are provided in an acute hospital, which for most local patients means Royal Stoke. Patients are in acute beds because they need to be for medical reasons – they are either ill or injured or recovering from illness, injury, a recent operation or need ongoing assessment.

Once they no longer need this medical care they should be discharged, and there will always be another patient who does need that care.

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Often, however, patients who no longer need medical care are simply not able to go home and care for themselves.

This is especially true for elderly or frail patients who have been in hospital some time. They need some care arranged at home.

One way of discharging people from the acute hospital so care can be arranged has been to send them to a community bed. It’s often said patients go there to ‘get back on their feet’.

We have never doubted the community hospitals provided quality care.

But there is now overwhelming evidence to show that however good the care, keeping patients in ANY hospital bed when they do not need to be there can be bad for them. That is true in the vast majority of cases.

They can quickly suffer a loss of physical condition and lose confidence in their ability to perform tasks they could do with ease just weeks previously. For many patients it can mean a total and permanent loss of independence – the opposite of getting back on their feet.

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Experienced doctors and nurses are far too familiar with this. It is something we see too often and needs to change.

A recent local survey showed 91 per cent of patients in a community bed need not be there. That is why we are making enormous efforts to discharge people back to their homes as soon as medically feasible, with a proper assessment of their care needs and the resources to deliver that care. Home is the best place to assess patients, not a hospital ward.

We have invested more than £23 million making these changes locally. They are not having the full impact we want yet, especially in Stoke-on-Trent, but are working much better in North Staffordshire. Stoke-on-Trent patients need to feel the same benefit as those in the Moorlands and Newcastle.

This is a prime example of how the NHS needs to adapt. Getting people home from hospital with the proper care is better for patients and better for the NHS.

We have temporarily closed some community beds as we no longer have patients to fill them, but more than 130 remain across care homes and a community hospital.